(808) Frequency of preeclampsia spectrum disorders by diabetes subgroup

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: We aim to determine the frequency of preeclampsia (PE) spectrum disorders among subjects with diabetes by subtype: Type 1 diabetes mellitus (T1DM); Type 2 DM (T2DM); gestational diabetes diet controlled (A1GDM); medication controlled GDM (A2GDM); and hyperglycemia in early pregnancy. We hypothesized a higher rate of PE with severe features among those with T1DM and T2DM.

Study Design: This was a retrospective cohort study of gravidas with adjudicated DM and PE diagnoses who delivered between 2010-2021. Hyperglycemia in early pregnancy was defined as a first trimester hemoglobin A1c between 5.7-6.4% or a fasting glucose of 92-125 mg/dL. Rates of gestational hypertension (HTN) and PE with or without severe features were analyzed. Superimposed PE was analyzed separately. Eclampsia and HELLP were included within PE with severe features. Student’s t-test and Chi-square analyses were performed. Logistic regression was performed to control for baseline differences between groups.

Results: 1151 subjects with DM were included in the analysis: 97 T1DM, 323 T2DM, 128 A1GDM, 155 A2GDM, and 448 early gestational hyperglycemia. First trimester body mass index was significantly higher in the T2DM and A2GDM groups (P < .001), while chronic HTN was more frequent in the T1DM and T2DM groups (p=.001) (Table 1). There were differences between age, parity, and race among DM subgroups; only race and parity differed by PE outcome. Excluding those with underlying chronic HTN, the rate of PE with and without severe features was highest in T1DM (25.0%, 18.8%) and T2DM (24.2%, 14.1%) (Table 2). T1DM and T2DM remained independent risk factors for PE without severe features (aOR 6.9, 95% CI 1.97-24.0; aOR 3.68, 95% CI 1.21-11.23) after controlling for parity and race. A sub-analysis among subjects with chronic HTN was performed: superimposed PE was most common in T1DM (17/33, 51.5%), T2DM (68/125, 54.4%) and A1GDM (15/29, 51.7%)(p=0.01).

Conclusion: The frequency of PE differed between DM subgroups. Those with pregestational DM are most likely to develop PE spectrum disorders and warrant close surveillance.

Primary & Presenting Author(s)

Lauryn C. Gabby, MD
Maternal Fetal Medicine Fellow
University of California, San Diego
San Diego, California, United States

Coauthor(s)

MJ
Marni B. Jacobs, MPH, PhD
University of California, San Diego
San Diego, California, United States
Kathy Zhang-Rutledge, MD
Fellow
University of California, San Diego
La Jolla, California, United States
MM
Morgan Meads, N/A
University of California, San Diego
San Diego, California, United States
DP
Donna Pham, BS
University of California, San Diego
La Jolla, California, United States
TL
Tzu Ning Liu, BS
University of California San Diego Medical School
San Diego, California, United States
AB
Annamarie Bucknum, BS
University of California, San Diego
La Jolla, California, United States
LL
Leah Lamale Smith, MD
University of California, San Diego
La Jolla, California, United States
MP
Mana M. Parast, MD, PhD
University of California, San Diego
San Diego, California, United States
Louise C. Laurent, MD, PhD
Maternal-Fetal Medicine Faculty
UC San Diego Medical Center
La Jolla, California, United States
GR
Gladys A. Ramos, MD
Clinica Professor
University of California
San Diego, California, United States